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Patient Forms

Patient Forms at Alate Health Interventional Radiology Clinic in Houston, TX

To help expedite your visit, please print and fill out these forms and bring them to your appointment. If you need help or have questions, contact us. We are conveniently located at 1213 Hermann Dr Suite 255, Houston, TX 77004.

Patient Information Form
Varicose Vein Questionnaire
Initial BPH Consultation Questionnaire
Fibroid New Patient Paperwork
Other New Patient Paperwork
Authorization to Release Healthcare Information
Fibroid Consultation Questionnaire
Prostate New Patient Paperwork
Vein/Leg Pain New Patient Paperwork

Patient Information Form
Authorization to Release Healthcare Information
Varicose Vein Questionnaire
Fibroid Consultation Questionnaire
Initial BPH Consultation Questionnaire

Patient Forms at Alate Health Interventional Radiology Clinic in Houston, TX

PATIENT INFORMATION FORM

Submit the Patient Information Form to help us deliver safe and coordinated care

PATIENT INFORMATION FORM
Patient Forms at Alate Health Interventional Radiology Clinic in Houston, TX

AUTHORIZATION TO RELEASE HEALTHCARE INFORMATION

Submit the Authorization to Release Healthcare Information form to ensure your records are shared according to your preferences

AUTHORIZATION TO RELEASE HEALTHCARE INFORMATION
Patient Forms at Alate Health Interventional Radiology Clinic in Houston, TX

VARICOSE VEIN QUESTIONNAIRE

Submit the Varicose Vein Questionnaire to assist in evaluating the severity of your symptoms and guide your care

VARICOSE VEIN QUESTIONNAIRE
Patient Forms at Alate Health Interventional Radiology Clinic in Houston, TX

FIBROID CONSULTATION QUESTIONNAIRE

Complete the Fibroid Consultation Questionnaire to provide essential information for evaluating your condition

FIBROID CONSULTATION QUESTIONNAIRE
Patient Forms at Alate Health Interventional Radiology Clinic in Houston, TX

INITIAL BPH CONSULTATION QUESTIONNAIRE

Complete the Initial BPH Consultation Questionnaire to provide important details for evaluating your symptoms

INITIAL BPH CONSULTATION QUESTIONNAIRE